Heterogeneity of breast cancer subtypes and survival among Hispanic women with invasive breast cancer in California

Abstract

Purpose There are limited data regarding breast cancer subtypes among Hispanic women. The current study assessed the distribution and prognosis of molecular subtypes defined by joint expression of the hormone receptors (HR; estrogen and progesterone) and human epidermal growth factor receptor 2 (HER2). Methods Using California Cancer Registry data, we identified Hispanic women diagnosed with invasive breast cancer from 2005–2010. Breast cancer subtypes were defined as HR+/HER2−, HR+/HER2+, HR−/HER2+, and HR−/HER2− (triple negative). We estimated breast cancer subtype frequencies and used polytomous logistic regression, Kaplan Meier survival plots and Cox regression to examine differences in relation to demographic and clinical characteristics. Results Among 16,380 Hispanic women with breast cancer, HR+/HER− subtype was most common (63%), followed by triple negative (16%), HR+/HER2+ (14%) and HR−/HER2+ (8%). Women in lower SES neighborhoods had greater risk of triple negative and HR−/HER2+ subtypes relative to HR+/HER2− (p<0.05). Hispanic women with triple negative and HR−/HER2+ tumors experienced poorer survival than those with HR+/HER− tumors. Breast cancer-specific mortality increased with decreasing SES, relative to the highest SES quintile, from HR=1.38 for quintile 4 to HR=1.76 for quintile 1 (lowest SES level). Conclusion Our findings indicate that Hispanic women residing in low SES neighborhoods had significantly increased risk of developing and dying from HR− than HR+ breast cancers. Similar patterns of subtype frequency and prognosis among California Hispanic women and studies of other racial/ethnic groups underscore the need to better understand the impact of SES on risk factor exposures that increase the risk of breast cancer subtypes with poor prognosis.

Genetics, Tumor Features and Treatment Response of Breast Cancer in Latinas

“…Banegas et al evaluated 16,380 Hispanic women with BC from the California Cancer Registry and found that hormone receptor (HR)+ HER-subtype was the most common (63%), followed by TNBC (16%) and HR+ HER2+ (14%). Women in lower socioeconomic status neighborhoods had greater risk of TNBC and HR-HER2+ subtypes (p < 0.05) [74]. Shavers of high histologic grade, high S-phase fractions, aneuploid and ER-negative tumors and more advanced disease stage BC in the Hispanic group [75].…”

Mammographic tumour appearance and triple-negative breast cancer associated with long-term prognosis of breast cancer death: A Swedish Cohort Study

“…While some studies have been conducted to relate these immunohistochemical (IHC) markers [1,2,[6][7][8][9][10][11][12][13][14], as well as the mammographic appearance and conventional risk factors [15][16][17], to the prognosis of breast cancer, very few studies have combined mammographic phenotypes with these IHC markers to assess their effects on the long-term prognosis of breast cancer [18,19]. Mammographic tumour appearance has been demonstrated to be an independent predictor for the risk of death from breast cancer [16].…”

Outcomes of Hispanic women with lymph-node positive, HER2 positive breast cancer treated with neoadjuvant chemotherapy and trastuzumab in Mexico

“…However, despite the recent advances in the treatment of HER2þ breast cancer, a recent large populationbased study of breast cancer subtypes among US Hispanic women found that Hispanic patients with HER2þ breast cancer had a higher breast cancer-specific mortality. This was higher for the HRÀ/HER2þ subtype, with a HR of 3.22 (95% CI 2.25e4.61) for USborn Hispanic women and of 1.91 (95% CI 1.41e2.58) for foreignborn Hispanics [5].…”

“…Hispanic women have a lower incidence of breast cancer but a higher breast cancer-related mortality rate compared with white women [4]. There is some evidence that points towards the fact that this is particularly true for women with hormone receptor (HR) negative breast cancer subtypes, both triple negative and HRÀ/HER2þ [5].…”

“…These figures have been confirmed in Hispanic patients treated in the U.S. [5,7]. In both the adjuvant and metastatic setting, randomized studies have highlighted the role of anti-HER2 agent trastuzumab in improving disease-free survival (DFS) and overall survival (OS) compared to chemotherapy alone [8e10].…”